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Medicare Part D

How Medicare Advantage Rebates Disadvantage Medicare’s Stand-Alone Drug Plan Market

Rebates that reduce Part D premiums for Medicare Advantage plans with drug coverage make it harder for stand-alone prescription drug plans (PDPs) to compete. That may contribute to instability in the PDP market relied on by people in traditional Medicare. The number of Part D stand-alone Rx drug plan options for the avg Medicare beneficiary has fallen by half in recent years, while Medicare Advantage drug plan options have risen.

Also: Medicare Part D Enrollment, Premiums, and Cost Sharing in 2026

Analyzing Changes in Medicare Part D Enrollment for 2026

Stand-Alone Drug Plans Cover a Larger Share of Part D Enrollees Living in the Most Rural Areas Than Medicare Advantage Plans

A Current Snapshot of the Medicare Part D Prescription Drug Benefit

Changes to Medicare Part D in 2024 and 2025 Under the Inflation Reduction Act and How Enrollees Will Benefit

NEW AND NOTEWORTHY

What to Know About Medicare Coverage of Telehealth

Congress has repeatedly extended pandemic-era flexibilities around Medicare coverage of telehealth, but most such flexibilities remain temporary. This brief answers key questions about the current scope of Medicare telehealth coverage, including both temporary and permanent changes adopted through legislation and regulation, and future policy considerations.

Examining the Potential Impact of Medicare’s New WISeR Model

A federal initiative to establish new prior authorization requirements in traditional Medicare, called the Wasteful and Inappropriate Service Reduction (WISeR) model, is likely to have only modest impact in its first year.

State Profiles for Dual-Eligible Individuals

This data collection draws on Medicare and Medicaid administrative data to present national and state-level information on people who are covered by both Medicare and Medicaid, referred to as dual-eligible individuals (also known as dually-enrolled beneficiaries).

Medicare Advantage

Medicare Advantage in 2026: Enrollment Update and Key Trends

More than half (55%) of eligible Medicare beneficiaries are enrolled in Medicare Advantage in 2026, continuing a decades-long shift toward private plans. Special Needs Plans have driven recent growth, with nearly 1 in 4 enrollees now in such plans.
To better understand trends in the growth of the Medicare Advantage program, this brief provides current information about enrollment, including by plan type and firm.

See Also: Medicare Advantage in 2026: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization

How Medicare Pays Medicare Advantage Plans: Issues and Policy Options

Medicare Advantage Enrollees Have Access to About Half of the Physicians Available to Traditional Medicare Beneficiaries

Medicare Advantage Insurers Made Nearly 53 Million Prior Authorization Determinations in 2024

Medicare Advantage Out-of-Pocket Limits: Variation & Trends

Prescription Drugs

What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid and the Medicare GLP-1 Bridge

CMS's temporary program to cover GLP-1 drugs for obesity in Medicare, called the BALANCE model, will not launch as scheduled on January 1, 2027. Instead, CMS is extending the Medicare GLP-1 Bridge, a separate short-term program that was to run from July to December 2026. It will now run through the end of 2027.

Key Facts About Medicare Drug Price Negotiation

Recent Trends in GLP-1 Use and Spending in Medicare

What to Know About Pharmacy Benefit Managers (PBMs) and Federal Efforts at Regulation

The IRA Has Improved Coverage of Drugs Selected for Medicare Price Negotiation

Data Visualization

The Facts About Medicare Spending

This interactive provides the facts on Medicare spending. Medicare, which serves 67 million people and accounts for 12 percent of the federal budget and 21 percent of national health spending, is often the focus of discussions about health expenditures, health care affordability and the sustainability of federal health programs. u003cbru003eu003cbru003eExplore data on enrollment growth, Medicare spending trends overall and per person, growth in Medicare spending relative to private insurance, spending on benefits and Medicare Advantage, Part A trust fund solvency challenges, and growth in out-of-pocket spending by beneficiaries.u003cbru003eu003cbru003eu003ca href=u0022https://www.kff.org/medicare/issue-brief/faqs-on-medicare-financing-and-trust-fund-solvency/u0022 data-type=u0022linku0022 data-id=u0022https://www.kff.org/medicare/issue-brief/faqs-on-medicare-financing-and-trust-fund-solvency/u0022u003eRelated:u003ca href=u0022https://www.kff.org/medicare/issue-brief/faqs-on-medicare-financing-and-trust-fund-solvency/u0022u003e FAQs on Medicare Financing and Trust Fund Solvencyu003c/au003eu003c/au003e

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  • External Review of Health Plan Decisions: An Overview of Key Program Features in the States and Medicare

    Report

    In 1978, the state of Michigan established a system to call on independent medical experts to help resolve disputes between health plans and patients about the medical necessity and appropriateness of care. Since then, twelve other states and the Medicare program have established similar kinds of external review programs. In the first half of 1998, five more states enacted external review laws (and two states passed laws modifying or expanding existing programs). The term "external…

  • Do We Know If Medicare Advantage Special Needs Plans Are Special?

    Report

    This report describes the history of special needs plans, how they fit into the larger Medicare Advantage marketplace, and what information could help assess whether these plans are performing differently from other Medicare Advantage plans. Special needs plans serve individuals such as those who are institutionalized, people covered under both Medicare and Medicaid, or those with chronic or disabling conditions. Enrollment in these plans doubled in the past year, and President Bush recently signed the…

  • How Much ‘Skin In The Game’ Do Medicare Beneficiaries Have? The Increasing Financial Burden of Health Care Spending, 1997-2003

    Issue Brief

    This study evaluated the changes in Medicare beneficiaries' health care spending between 1997 and 2003, and found beneficiaries spent a growing share of their income on health care. The results showed that median out-of-pocket health spending increased from 11.9% of income in 1997 to 15.5% in 2003, and about four in 10 beneficiaries spent at least one-fifth of their income on health care in 2003. Researchers using data from the Medicare Current Beneficiary Survey found…

  • Health Coverage and Expenses: Impact on Older Women’s Economic Well-Being

    Issue Brief

    In this article in the Journal of Women, Politics & Policy, researchers from the Kaiser Family Foundation examine how health issues that women face over the course of their lives, as well as policies that shape Medicare, Medicaid and other supplemental coverage, can affect retired women's economic well-being. They found that women's health care expenses were higher than men's; that older women paid for a greater share of their total spending out of pocket and that…

  • Tracking Medicare Health and Prescription Drug Plans Report—May 2010

    Report

    This brief presents current monthly data on Medicare Advantage plan participation, enrollment and penetration. It also summarizes recent activities by the Centers for Medicare and Medicaid Services (CMS), participating health plans, and the research community pertaining to the Medicare Advantage program and prescription drug plans that began serving the Medicare population in January 2006. The report was prepared by researchers at Mathematica Policy Research Inc. May 2010 Report (.pdf) Previous Tracking Reports

  • e-Health and the Elderly: How Seniors Use the Internet for Health

    Poll Finding

    A national Kaiser Family Foundation survey of older Americans found that as the Internet becomes an increasingly important resource for informing decisions about health and health care options, less than a third (31%) of seniors (age 65 and older) have ever gone online, but that more than two-thirds (70%) of the next generation of seniors (50-64 year-olds) have done so. The differences among seniors and 50-64 year-olds are striking and indicate that online resources for…

  • Medicare Part D Issue Briefs

    Issue Brief

    These issue briefs, prepared by the Centers for Medicare Advocacy, Inc., provide information about how the Medicare drug benefit will affect beneficiaries. The briefs address issues related to dual eligibles, residents of nursing home and assisted living facilities, and the Part D exceptions and appeals processes. Medicare Part D: Issues for Dual Eligibles on the Eve of Implementation Medicare Prescription Drug Coverage for Residents of Nursing Homes and Assisted Living Facilities: Special Problems and Concerns…

  • Kaiser Health Poll Report Survey – Selected Findings on Seniors’ Views of the Medicare Prescription Drug Benefit

    Poll Finding

    Kaiser Health Poll Report Survey – Selected Findings on Seniors' Views of the Medicare Prescription Drug Benefit This February 2006 Kaiser Family Foundation tracking poll finds that 45% of seniors say they have enrolled or plan to enroll in a drug plan, 29% say they do not intend to enroll in a drug plan and another 23% say they are uncertain. The majority of those who do not plan to enroll say they have another…

  • Dual Eligibles: Medicaid’s Role for Low-Income Medicare Beneficiaries

    Fact Sheet

    This updated fact sheet describes the nearly 8.9 million "dual eligibles," the low-income elderly and persons with disabilities who are enrolled in both Medicare and Medicaid, why this population needs Medicaid, what services they receive from Medicaid, and what the new health reform law may mean for them. Fact Sheet (.pdf)

  • Issue Briefs Describe Changes in Private Plan Market and Effects on Medicare Beneficiaries

    Issue Brief

    These two issue briefs describe the different types of private plan options available to people on Medicare, identify key characteristics of the organizations offering the new Medicare drug benefit, and analyze how companies are positioning themselves to attract Medicare enrollees. The Growth of Private Plans in Medicare, 2006 The Landscape of Private Firms Offering Medicare Prescription Drug Coverage in 2006